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Sciaccaluga C, Ghionzoli N, Mandoli GE, Sisti N, D'Ascenzi F, Focardi M, Bernazzali S, Vergaro G, Emdin M, Valente S, Cameli M. The role of non-invasive imaging modalities in cardiac allograft vasculopathy: an updated focus on current evidences. Heart Fail Rev 2021; 27:1235-1246. [PMID: 34383194 PMCID: PMC9197817 DOI: 10.1007/s10741-021-10155-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/24/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is an obliterative and diffuse form of vasculopathy affecting almost 50% of patients after 10 years from heart transplant and represents the most common cause of long-term cardiovascular mortality among heart transplant recipients. The gold standard diagnostic technique is still invasive coronary angiography, which however holds potential for complications, especially contrast-related kidney injury and procedure-related vascular lesions. Non-invasive and contrast-sparing imaging techniques have been advocated and investigated over the past decades, in order to identify those that could replace coronary angiography or at least reach comparable accuracy in CAV detection. In addition, they could help the clinician in defining optimal timing for invasive testing. This review attempts to examine the currently available non-invasive imaging techniques that may be used in the follow-up of heart transplant patients, spanning from echocardiography to nuclear imaging, cardiac magnetic resonance and cardiac computed tomography angiography, weighting their advantages and disadvantages.
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Affiliation(s)
- C Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy.
| | - N Ghionzoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - G E Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - N Sisti
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - F D'Ascenzi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Focardi
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - S Bernazzali
- Department of Cardiac Surgery, University Hospital of Siena, Siena, Italy
| | - G Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - M Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.,Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Valente
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - M Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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Tang P, Ma S, Dong M, Wang J, Chai S, Liu T, Li J. Effect of interleukin-6 on myocardial regeneration in mice after cardiac injury. Biomed Pharmacother 2018; 106:303-308. [PMID: 29966974 DOI: 10.1016/j.biopha.2018.06.090] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022] Open
Abstract
Our aim was to investigate the role of interleukin-6 (IL-6) in myocardial regeneration from mice after cardiac injury. The newborn mice were divided into the following 4 groups (16 in each group): sham group, model group, IL-6-/- group (IL-6 knockout) and IL-6 group (IL-6 overexpression). Electrocardiography was performed on all mice and found higher LVEDD, LVESD and IVST and lower LVEF and LVFS in the IL-6 group compared with the sham group. Using HE staining, severe myocardial injury combined with infarction and fibrosis were observed in the IL-6-/- group, while the damaged myocardial tissue was repaired to some extent in the IL-6 group. The expression of IL-6 in the IL-6 group were significantly up-regulated. BrdU immunofluorescence found that the IL-6-/- group had the least number of BrdU positive cells, while the IL-6 group had more BrdU positive cells than the model group and the IL-6-/- group. Expressions of IL-6, cyclinD1 and Bcl-2 in the IL-6 group were up-regulated compared with other groups. In conclusion, IL-6 overexpression could enhance cardiomyocyte proliferation and relevant protein expression in mice myocardium, thus promoting cardiac regeneration.
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Affiliation(s)
- Peizhe Tang
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China.
| | - Shengjun Ma
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Mingfeng Dong
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Jiantang Wang
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Shoudong Chai
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Tao Liu
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
| | - Jindong Li
- Department of Cardiovascular Surgery, Liaocheng People's Hospital, Liaocheng, Shandong Province, China
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Barakat AF, Sperry BW, Starling RC, Mentias A, Popovic ZB, Griffin BP, Desai MY. Prognostic Utility of Right Ventricular Free Wall Strain in Low Risk Patients After Orthotopic Heart Transplantation. Am J Cardiol 2017; 119:1890-1896. [PMID: 28390683 DOI: 10.1016/j.amjcard.2017.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 01/13/2023]
Abstract
Global longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive measure of regional left and right ventricular (LV and RV) dysfunction, before onset of overt systolic dysfunction. We sought to evaluate the prognostic utility of measuring LV-GLS and RV free wall strain (FWS) in low risk patients at 1 year after orthotopic heart transplantation (OHT). We retrospectively studied 96 OHT recipients (age 52 ± 14 years, 64% men) free of antibody-mediated rejection or moderate to severe coronary allograft vasculopathy (CAV, grade 2 to 3) at 1 year after transplant. LV-GLS and RV-FWS were calculated using EchoPAC software. Cox models were developed after adjusting for the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score (post-transplant risk score), with the primary outcome of death, moderate to severe CAV, or treated rejection. At 1 year after transplant, LV ejection fraction and RV fractional area change (FAC) were 58 ± 7% and 42 ± 10%, respectively. LV-GLS was -17.0 ± 3.3% and RV-FWS -16.4 ± 4.5%. At an average follow-up of 4.5 years, 28 patients met the primary end point (10 death, 5 vasculopathy, 17 rejection). In sequential Cox models, markers of RV function were associated with the primary outcome (RV-FAC, p = 0.012; RV-FWS, p = 0.022), while LV ejection fraction and LV-GLS were not. We conclude that in low risk patients 1 year after OHT, markers of RV function (RV-FAC and RV-FWS) are independently associated with incident rejection, CAV, and death. Markers of RV dysfunction could potentially be incorporated into risk scores and future prospective studies to risk stratify patients after OHT.
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Nawaytou HM, Yubbu P, Montero AE, Nandi D, O'Connor MJ, Shaddy RE, Banerjee A. Left Ventricular Rotational Mechanics in Children After Heart Transplantation. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.004848. [PMID: 27609818 DOI: 10.1161/circimaging.116.004848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular (LV) dysfunction after orthotopic heart transplantation (OHT) is multifactorial and can be an indicator of graft rejection or coronary artery vasculopathy. Analysis of rotational mechanics may help in the early diagnosis of ventricular dysfunction. Studies describing the left ventricular rotational strain in children after OHT are lacking. It is important to establish the baseline rotational mechanics in pediatric OHT to pursue further studies in this population. METHODS AND RESULTS Rotational strain measured by speckle tracking was compared in 32 children after OHT, with no evidence of active rejection or coronary artery vasculopathy with 35 age-matched normal controls. Twelve OHT patients and 13 controls underwent moderate exercise with pre- and postexercise echocardiography. Torsion, slope of the systolic limb of the torsion-radial displacement loop, and the untwist rate were significantly higher in OHT patients (torsion: median 2.7°/cm [Q1-Q3, 2.3-3.2] versus 2.3°/cm [Q1-Q3, 1.9-2.7]; P=0.03, torsion-radial displacement loop: 2.7°/mm [Q1-Q3, 2.1-3.6] versus 2.0°/mm [Q1-Q3, 1.6-2.7]; P=0.008, indexed peak untwist rate: -21.6°/s/cm [Q1-Q3, -24.3 to -15.7] versus -17.1°/s/cm [Q1-Q3, -19.6 to -13.3]; P=0.01). Contrary to controls, OHT recipients were unable to increase torsion with exercise (OHT: 2.8°/cm [2.7-3.2] versus 3°/cm [2.4-3.5]; P=0.81, controls: 2.2°/cm [2-2.6] versus 3°/cm [2.4-3.7]; P=0.01, pre and post exercise, respectively). The systolic slope of the torsion-radial displacement loop relationship decreased with exercise in most OHT patients. CONCLUSIONS Baseline rotational strain in OHT patients is higher than normal with a blunted response to exercise. The slope of torsion-radial displacement loop, and its response to exercise, may serve as a marker of left ventricular dysfunction in OHT patients.
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Affiliation(s)
- Hythem M Nawaytou
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania
| | - Putri Yubbu
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania
| | - Andrea E Montero
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania
| | - Deipanjan Nandi
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania
| | - Matthew J O'Connor
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania
| | - Robert E Shaddy
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania
| | - Anirban Banerjee
- From the Division of Cardiology, The Children's Hospital of Philadelphia, The Perelman School of Medicine at The University of Pennsylvania.
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Lopez-Candales A, Hernandez-Suarez DF. Strain Imaging Echocardiography: What Imaging Cardiologists Should Know. Curr Cardiol Rev 2017; 13:118-129. [PMID: 27799029 PMCID: PMC5452148 DOI: 10.2174/1573403x12666161028122649] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 01/30/2023] Open
Abstract
Despite recent advances in clinical imaging, echocardiography remains as the most accessi-ble and reliable noninvasive. Since knowledge of left ventricular systolic function remains so critically important in determining prognosis; every effort should be made to prevent subjective estimations. The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics; but also allows for early detection of subclinical left ventricular dysfunction. This review outlines the basic concepts of strain imaging to better understand the mechanism of myocardial function as well their applicability in the least common cardiac diagnosis among current clinical practice.
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Affiliation(s)
- Angel Lopez-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences Building, PO Box 365067, San Juan, Puerto Rico
| | - Dagmar F Hernandez-Suarez
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences Building, PO Box 365067, San Juan, Puerto Rico
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Post-transplant surveillance for acute rejection and allograft vasculopathy by echocardiography: Usefulness of myocardial velocity and deformation imaging. J Heart Lung Transplant 2017; 36:117-131. [DOI: 10.1016/j.healun.2016.09.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/18/2022] Open
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Friedberg MK. Echocardiographic Detection of Heart Transplant Graft Dysfunction. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005439. [DOI: 10.1161/circimaging.116.005439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark K. Friedberg
- From the Department of Pediatrics, Division of Cardiology, The Labatt Family Heart Center, Hospital for Sick Children, and the University of Toronto, Ontario, Canada
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